Plasma C‐type lectin‐like receptor 2 as a predictor of death and vascular events in patients with acute ischemic stroke

Abstract

Background and purpose C‐type lectin‐like receptor 2 (CLEC‐2) has prominent involvement in platelet activation, which is increased in coronary heart disease and acute ischaemic stroke (AIS) and is associated with stroke progression and stroke prognosis. Here, the aim was to examine the prognostic value of CLEC‐2 in death and vascular event recurrence in AIS patients. Methods In all, 352 patients with AIS were studied prospectively. All patients were followed up for 1 year. Death for all vascular events and a combination of death and vascular diseases (recurrent stroke, myocardial infarction, hospitalized and treated angina, hospitalized and treated peripheral arterial disease) were recorded. Results During 1 year of follow‐up, 46 patients (14.2%) experienced death or combined end‐points (23 death and 46 combined end‐points). Plasma CLEC‐2 (pCLEC‐2) was significantly associated with an increased risk of death and combined events of death and vascular diseases after adjusting for age, sex, history of hypertension, diabetes mellitus and coronary artery disease, and National Institutes of Health Stroke Scale scores. Each 1 SD higher log‐transformed pCLEC‐2 was associated with a 4.27‐fold (hazard ratio 4.27, 95% confidence interval 1.71–10.65) increased risk for death and a 2.42‐fold increased risk for combined end‐points (hazard ratio 2.42, 95% confidence interval 1.52–3.86). The optimal cut‐off point of pCLEC‐2 for predicting death was 184.38 pg/ml. Conclusions Higher pCLEC‐2 levels at admission were associated with increased risk of death and combined events of death and vascular diseases in patients with AIS, which indicated that pCLEC‐2 is an important prognostic factor for AIS.

Soluble Platelet Release Factors as Biomarkers for Cardiovascular Disease

“…Two articles originating from the same cohort of AIS patients consisting of 323 individuals with a follow-up of 1 year showed that sCLEC-2 might be used as a predictor for AIS; the elevated level of the biomarker was significantly correlated with stroke progression and death. Patients with the highest sCLEC-2 level had an 8-fold higher risk of progressive stroke or death compared to the patients in the lowest quartile (140,141).…”

“…Ischemic stroke, not based on cardiac embolism, is predominantly a consequence of atherothrombosis in the carotid and other cranial arteries (130). Platelet activation as measured by release markers during an acute ischemic stroke (AIS) has been demonstrated in many studies, showing elevated plasma levels of sP-selectin (131)(132)(133)(134)(135)(136)(137)(138), sCD40L (134), sGPVI (139), and sCLEC2 (140,141) in comparison to healthy volunteers (Table 4, Supplementary Table 1).…”

The Role of CLEC-2 and Its Ligands in Thromboinflammation

“…A study conducted on Chinese patients with acute ischemic stroke reported high levels of plasma CLEC-2, which was associated with poor prognosis and significantly increased risk of death (45). Other studies have also shown that plasma CLEC-2 is a predictor of cerebrovascular disease recurrence in patients with acute ischemic stroke (46). Podoplanin inhibitors mitigated the pathological changes after cerebral ischemiareperfusion in a mouse model of middle cerebral artery occlusion-induced stroke, which indicates a potential role of the CLEC-2/podoplanin axis in thromboinflammation (47).…”

Platelets in Thrombo-Inflammation: Concepts, Mechanisms, and Therapeutic Strategies for Ischemic Stroke

“…Nonetheless, plasma levels of soluble CLEC-2 (sCLEC-2) could recently be positively correlated with stroke progression, recurrence of vascular events, and risk of death in patients with AIS, making sCLEC-2 a promising prognostic marker for AIS (►Table 1). 102,103…”